Contact

Payer

Pharma

Provider

Formulary guidance and transparency from P&T to point of care

Perspectives on Insulin Management

Posted by Leslie Small on Apr 18, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
Read More

Topics: Industry Trends, Market Access, Data & Analytics, Provider, Payer

Radar On Market Access: CMS Finalizes Medicare Rates, Unveils '20 Opioid Policies

Posted by Judy Packer Tursman on Apr 18, 2019

CMS recently released its annual payment information and policy updates for Medicare Advantage, MA Prescription Drug (MA-PD) and stand-alone Prescription Drug Plans, underscoring the need for a better approach to opioid monitoring and management, AIS Health reported.

Yet overall, industry experts say perhaps the most eye-catching features of CMS's 2020 MA and Part D Rate Announcement and final Call Letter are the better-than-anticipated pay rate and the lack of worrisome new mandates, policy changes or major technical issues.
 
Read More

Topics: Industry Trends, Provider, Payer

Radar On Market Access: PBM Trade Group Offers Alternative to Proposed Drug Rebate Changes

Posted by Leslie Small on Apr 16, 2019

One day before executives from the country's largest PBMs testified on Capitol Hill about rising drug prices, the Pharmaceutical Care Management Association (PCMA), which lobbies on behalf of PBMs, submitted a comment letter telling the Trump administration in no uncertain terms that a proposed rule aiming to upend the prescription drug rebate system will do more harm than good, AIS Health reported.

The proposed rule, released Jan. 31, would remove safe-harbor protections under the federal anti-kickback statute for rebates paid by drug manufacturers to PBMs, Part D plans and Medicaid managed care organizations, and it would create a new safe-harbor protection for point-of-sale drug discounts.
 
Read More

Topics: Industry Trends

Trends That Matter for Cancer Care

Posted by Angela Maas on Apr 11, 2019

With more targeted and effective therapies launching to treat a variety of cancers, much of the focus has been not only on their efficacy but their costs, particularly to payers. A recent report from the physician perspective highlights their impact as far as cost on not only those stakeholders but also the patients they serve, AIS Health reported.

The Association of Community Cancer Centers released its 2018 Trending Now in Cancer Care Survey in February. Responding to the survey were 205 individuals from community cancer centers, academic centers, teaching hospitals and independent practices.
 
Read More

Topics: Industry Trends, Data & Analytics

Radar On Market Access: Drugmakers Are Trying Array of Tactics to Counter Copay Accumulator Programs

Posted by Angela Maas on Apr 9, 2019

As more health plans are implementing copay accumulator programs, manufacturers are struggling to find ways to counter them, AIS Health reported.

Drugmakers may want to "evaluate [their specialty pharmacy] network and consider narrowing it to independent SPs that will accept contracts precluding sharing with payers/PBMs the patients who are participating in your copay offset program," recommends a recent survey report from Zitter Insights.
 
Read More

Topics: Industry Trends, Provider, Payer

Perspectives on the First-Ever Digital Oncology Medicine

Posted by Angela Maas on Apr 4, 2019

As innovations in digital capabilities continue to be used with various health care products, Proteus Digital Health, Inc. is developing a suite of what it terms digital medicines. And while the company has been working on such products for a few years, it recently came out with the first such product within the oncology space, AIS Health reported.

Proteus is partnering with Fairview Health Services and the University of Minnesota Health to offer oral capecitabine combined with an ingestible sensor to treat stage 3 and stage 4 colorectal cancer patients.
 
Read More

Topics: Specialty, Industry Trends, Market Access, Product Release, Data & Analytics

Radar On Market Access: Insurer Tools Aim to Help Members Save on Prescription Drugs

Posted by Leslie Small on Apr 4, 2019

As many Americans continue to struggle to afford their medications, health insurers and their PBMs are responding with tools that help consumers not only understand the cost of drugs before prescriptions are filled, but also find ways to spend less money on them, AIS Health reported.

However payers choose to design such tools, two keys to their success include making improvements over time and making sure members know about them before they might need them, according to Nathan Foco, senior director of market and sales intelligence for Michigan-based Priority Health.
 
Read More

Topics: Industry Trends, Data & Analytics, Provider, Payer

Trends That Matter for Cystic Fibrosis Medications

Posted by Jane Anderson on Mar 28, 2019

Payers typically use tools such as prior authorization and utilization review to manage cystic fibrosis treatments, but PBM experts say they are on the cusp of implementing more innovative strategies that might help to improve adherence while addressing the cost of cystic fibrosis drugs, AIS Health reported.

Cystic fibrosis, an inherited chronic disease that attacks the lungs and digestive organs, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CFTR modulators and other therapies carry a high price tag, typically costing $250,000 to $368,000 per year. Other drugs, most of which do not have generic equivalents, can add tens of thousands of dollars to that total.
 
Read More

Topics: Specialty, Industry Trends, Market Access, Data & Analytics, Provider, Payer

Perspectives on Novel Drug Management in 2019

Posted by Angela Maas on Mar 21, 2019

With the FDA approving multiple novel new therapies over the past couple of years, we should expect to see more of the same moving forward. But that innovation is not cheap, and the pharmaceutical industry likely will continue to offer products at higher price points than ever before, AIS Health reported.

As payers struggle to rein in high specialty drug prices, many have turned to copay accumulator programs, and this trend shows no signs of slowing. "There was an increased focus on copay accumulator programs in 2018," comments Amy Nash, Pharm.D., president of RelianceRx, the specialty pharmacy affiliate of Independent Health. She tells AIS Health she expects to see "further refinement of copay accumulator programs from payers and additional strategies from pharma to prevent them."
 
Read More

Topics: Specialty, Industry Trends, Market Access, Product Release, Data & Analytics

Radar On Market Access: As Insulin Prices Balloon, Insurers Try to Offer Some Relief

Posted by Leslie Small on Mar 21, 2019

Amid increasing public scrutiny of rising insulin prices, some health insurers are taking matters into their own hands to help their diabetic members afford the lifesaving medications, AIS Health reported.

At the integrated health system HealthPartners, the members who are hardest hit by rising insulin prices are those in high-deductible health plans, says Young Fried, vice president of pharmacy plan services. But she says insulin affordability is also an issue for Medicare members who are in the Part D "doughnut hole." 
 
Read More

Topics: Industry Trends, Data & Analytics, Provider, Payer